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Table 6.1 11 presents additional details regarding the difference between narrative and systematic reviews. Although it is possible to have systematic reviews that focus on prognosis and diagnosis (and harm) issues, in this chapter, we will focus on therapy (and harm) issues. 9, 10 In contrast, authors of trustworthy reviews use systematic, transparent, and comprehensive methods to retrieve, select, critically appraise, and summarize all the available evidence regarding the effectiveness of an intervention, prognosis, and diagnosis questions. Although this type of review may be useful for dental students (and sometimes dentists) who are interested in background information, the failure of authors to systematically collect and process the data makes the conclusions that arise from such articles potentially misleading. In narrative reviews, authors discuss one or more aspects related to a particular condition or disease (that is, etiology, diagnosis, prognosis, or therapy and management). For this reason, clinicians interested in using review articles must be able to distinguish between narrative and systematic reviews. 8 What Is the Difference Between Narrative and Systematic Reviews?Īuthors of many articles published in the dental literature refer to their work as “reviews” only a small number of these articles, however, are systematic reviews. If these bias-reducing strategies (that is, the systematic review process) are in place, then readers can trust that the appropriate analysis will provide the best available estimate of the effect of an intervention or exposure. Systematic reviews represent an efficient way to learn about the available evidence for an intervention or exposure.Īccording to the Cochrane Collaboration, 8 a systematic review is defined as “a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review.” Like primary observational studies and randomized controlled trials, systematic reviews represent a type of study that requires implementation in a manner that minimizes the risk of bias. This overwhelming amount of information can be impossible to manage for any health care provider, including dentists. Of these, approximately 1,500 were dental trials. According to the Medline (PubMed) Trend Database, 7 more than 30,000 randomized controlled trials (RCTs) were published in 2012. Keeping updated in knowledge related to any clinical discipline is challenging. You consult the Cochrane Library and find a recently published systematic review that addresses this issue. You have been in the habit of prescribing chlorhexidine in cases such as this one however, you wonder if this medication is actually of any use in decreasing the patient’s risk of experiencing dry socket. Among other measures, you decide to minimize your patient’s risk of having alveolar osteitis (dry socket) as a postoperative complication. The patient asks if she will need to attend many follow-up appointments, because traveling from her home to your clinic is a burden. After conducting a clinical examination, you recommend that the tooth be extracted. While working at a clinic in a remote rural location, you meet with a 55-year-old woman who has been referred to you for treatment of open caries on tooth #20, which the referring clinician has diagnosed as having irreversible pulpitis. In a subsequent chapter, we describe how to use evidence-based clinical practice guidelines. In addition, readers will learn how to interpret and use the results presented in the systematic review to inform clinical decisions. 5 In this chapter, we explain how to use a systematic review to answer a clinical question, introduce and describe the basic concepts for understanding the design of a systematic review, and explain how to use these concepts to critically appraise such studies. In the previous chapters in this book, we introduced the process of evidence-based dentistry (EBD) 1 and explained how to search for evidence to inform clinical practice 2 and how to use articles about therapy, 3 harm, 4 and diagnosis. How Can I Apply the Results to Patient Care?.Why Are Systematic Reviews Considered to Be a Study Design?Ĭritically Appraising Systematic Reviews to Inform Clinical Decisions What Is the Difference Between Narrative and Systematic Reviews?
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